Cascio Antonio, De Caridi Giovanni, Lentini Salvatore, Benedetto Filippo, Stilo Francesco, Passari Gabriele, Iaria Chiara, Spinelli Francesco, Pappas Georgios
Department of Human Pathology, Policlinico "G. Martino" University Hospital, University of Messina, Messina, Italy.
Vector Borne Zoonotic Dis. 2012 Oct;12(10):827-40. doi: 10.1089/vbz.2012.0965. Epub 2012 Sep 20.
Human brucellosis is a disease of protean manifestations, and has been implicated in complications and focal disease in many human organ systems. However, little is collectively known about the background, the course, the clinical characteristics, the diagnostic issues raised, and the short- and long-term therapeutic approaches in patients with aortic involvement as a complication of brucellosis. With the aim to glean from the literature useful information to better understand and manage this complication, a computerized search without language restriction was conducted using PubMed and SCOPUS. An article was considered eligible for inclusion in the systematic review if it reported data on patients with involvement of the aorta due to a Brucella infection. The epidemiologic and clinical characteristics of 44 cases of brucellar aortic involvement found through the systematic review of the literature were analyzed together with those of two new cases that we treated in the recent past. This complication involved the ascending thoracic aorta in 18 cases (in 16 of them as a consequence of brucellar endocarditis), and the descending thoracic aorta or the abdominal aorta in the remaining 30 cases. In the latter it was associated with spondylodiscitis of the lumbar spine in 13 cases. History of or symptoms indicative of brucellosis were not universally present. Brucellar aortic involvement represents a possibly underdiagnosed and underreported complication with major morbidity and mortality potential. Experience with novel invasive therapeutic approaches remains limited. Early suspicion through detailed history and diagnosis, aided by advances in aortic imaging, would allow for better planning of therapeutic interventions.
人类布鲁氏菌病临床表现多样，可累及人体多个器官系统并引发并发症和局灶性疾病。然而，对于布鲁氏菌病并发症累及主动脉的患者，其背景、病程、临床特征、诊断问题以及短期和长期治疗方法，目前总体了解甚少。为了从文献中收集有用信息，以便更好地理解和处理这一并发症，我们使用PubMed和SCOPUS进行了无语言限制的计算机检索。如果一篇文章报道了布鲁氏菌感染导致主动脉受累患者的数据，则被认为符合纳入系统评价的条件。我们将通过文献系统评价发现的44例布鲁氏菌性主动脉受累病例的流行病学和临床特征，与我们近期治疗的2例新病例的相关特征进行了分析。这一并发症累及升主动脉18例（其中16例继发于布鲁氏菌性心内膜炎），其余30例累及降主动脉或腹主动脉。在后一组病例中，13例与腰椎椎体间感染相关。布鲁氏菌病病史或相关症状并非普遍存在。布鲁氏菌性主动脉受累可能是一种诊断不足和报告不足的并发症，具有较高的发病率和死亡率。新型侵入性治疗方法的经验仍然有限。通过详细病史和诊断进行早期怀疑，并借助主动脉成像技术的进步，将有助于更好地规划治疗干预措施。
